Background Extensive invasion of the maternal decidua by extravillous trophoblast is considered of critical importance for implantation and placentation in humans, the decidua being viewed as a passively invaded tissue. In this study, we examined whether decidual cells might contribute to the highly dynamic processes at the fetal-maternal interface by active movement.Method SPrimary endometrial stromal cells (ESCs) or the telomerase-immortalized ESC line, St-T1b, was induced to decidualize or was left undifferentiated. The AC-1M88 cell line served as a model for extravillous trophoblast cells. Motility of ESCs and trophoblast cells was monitored in transwell invasion and migration assays under co-culture conditions. Secretion of matrix metalloproteinases (MMPs) was assessed by gelatin zymography.Result SAC-1M88 cell invasiveness was unaffected by the presence of ESCs, irrespective of their decidualization status. Surprisingly, decidualized ESCs were significantly more invasive than undifferentiated cells, and this invasive activity was strongly enhanced when cells were cultured in direct contact with AC-1M88 cells. Conditioned medium from AC-1M88 cells also stimulated migration and invasion of ESCs. Secretion of MMP-2 and-9 by ESCs was increased upon decidualization.Conclusion SEnhanced motility and invasive capacity of decidualized ESCs in the presence of trophoblastic cells lead us to hypothesize a major contribution of the decidua in encapsulating the early conceptus and supporting subsequent trophoblast invasion. Our findings thus suggest a far more active role of the decidua in the implantation process than hitherto recognized.

The care of transsexual patients is a lifelong and honestly interdisciplinary task for health professionals. The knowledge of the diagnostic criteria and treatment guidelines is of enormous importance for the general practitioner. Transsexualism is not an issue of sexuality and not a disease in the traditional sense but rather a disorder of gender identity (gender dysphoria). Transsexual patients require multiprofessional medical and social assistance to enable them a suitable life in an appropriate quality. First of all, there is a need of diagnosis and psychotherapy of gender dysphoria by an experienced mental health professional. Prior cross sex hormonal treatment a written "Mental Health Professional's Documentation Letter for Hormone Therapy" is needed. Prior each hormone prescription a counselling and a screening for risk factors or accompanying diseases is recommended. Guidelines are published for the cross sex hormone treatment. The collaboration with a centre with well experienced health professionals or contact with Transgender teams for the treatment of transsexual patients is recommended. Transsexual patients require life-long multi-professional medical attention and care, and they will gratefully accept this offer.

The care of transsexual patients is a lifelong and honestly interdisciplinary task for health professionals. The knowledge of the diagnostic criteria and treatment guidelines is of enormous importance for the health professional. Transsexualism is not an issue of sexuality and not a disease in the traditional sense but rather a disorder of gender identity (gender dysphoria). Transsexual patients require multiprofessional medical and social assistance to enable them a suitable life in an appropriate quality. First of all, there is a need of diagnosis and psychotherapy of gender dysphoria by an experienced mental health professional. Prior cross sex hormonal treatment a written "Mental Health Professional's Documentation Letter for Hormone Therapy" is needed. Prior each hormone prescription a counselling and a screening for risk factors or accompanying diseases is recommended. Guidelines are published for the cross sex hormone treatment. The collaboration with a centre with well experienced health professionals or contact with Transgender teams for the treatment of transsexual patients is recommended. Transsexual patients require life-long multi-professional medical attention and care, and they will gratefully accept this offer.